Provider Demographics
NPI:1215936760
Name:LATTUS, VIRGINIA RENEE (PT)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:RENEE
Last Name:LATTUS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5028 OLD PIERCE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH FULTON
Mailing Address - State:TN
Mailing Address - Zip Code:38257-8108
Mailing Address - Country:US
Mailing Address - Phone:731-884-0744
Mailing Address - Fax:731-884-0748
Practice Address - Street 1:1720 E REELFOOT AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-6047
Practice Address - Country:US
Practice Address - Phone:731-884-0744
Practice Address - Fax:731-884-0748
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT5883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist